Errol MillerLAST WEEK while travelling I came across a newspaper report of the World Health Organisation (WHO) league tables for health care systems in the world. The WHO assessed health system worldwide based on five indicators: overall level of population health; health inequalities within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).
The WHO came to the conclusion that although significant progress has been made in past decades, virtually all countries are under-utilising the resources that are available to them. This leads to large numbers of preventable deaths and disabilities, unnecessary suffering, injustice, inequality and denial of an individual's basic rights to health. Further, spending more on health care systems does not by itself produce better health care for all.
Within the context of this overall judgement, the WHO ranked 191 countries of the world using its own data and assessment tools. France ranked number one. Sierra Leone ranked 191. The United States ranked 37 just above Cuba that ranked 39. Jamaica ranked number 53. Ahead of Jamaica were 26 European countries, nine Arab countries of the Middle East and North Africa, Israel, Cyprus, Colombia and Chile of South America, Canada and the United States of North America, Australia, New Zealand and four Caribbean countries. The highest ranked Caribbean country was Dominica, which ranked 35, that is, ahead of the United States, followed by Cuba, Barbados at 45 and the Dominican Republic at 51.
One Monday morning I listened to a part of the discussion of the Jamaican health system on the Breakfast Club which involved doctors, nurses, hospital administrators and commentators. It would appear that none of the participants in that discussion was aware of the WHO Report. Listening to that discussion no one could be led to believe that the Jamaican health care system ranked in the top 30 per cent of health care systems of the world.
My point is not in any way to contradict the problems and frustrations expressed by the participants to that discussion. Rather it is to point out some of the features that characterise discussions of many aspects of our national life at the moment. There are three points that struck me as I listened to that discussion and reflected on the findings of the WHO Report.
First, in the advocacy for more resources and the anxiety to improve what exists by highlighting problems, there is little or no room to acknowledge achievement and the excellent work professionals working in various fields are doing, and that includes the professionals themselves.
Clearly Jamaica's ranking by the WHO must be due to a large extent on what our doctors, nurses and administrators are doing despite the limitations of resources. It would appear, however, that not even these persons are willing to credit themselves with any achievement.
Second, many assessments of mass system discussions locally assume that perfection exists and we in Jamaica are not achieving it primarily because of wicked politicians, uncaring professionals, incompetent administrators and ignorant clients. Missing is the fact that mass systems of health, social services etc., are challenging people everywhere. Perfection or near perfection is an ideal towards which countries are striving against very different odds.
Subjective
impressions
Third, objective analysis based on hard data is lacking in many instances and instead there is heavy reliance on anecdotal information and subjective impressions. Individual occurrences are generalised way beyond their relevance and system-wide importance.
These features in themselves could be harmless were it not for the degree to which people have become demoralised and disillusioned. This could lead to hasty and rash decision-making that destroys the very things that we seek to build. My plea is for greater balance and objectivity in approaching the problems in the country.
The WHO Report and Jamaica's ranking is no cause for complacency or reason to deny the problems that confront health care in Jamaica. Rather, it is a caution not to throw out the baby with the bath water because we are doing some things right that need to be acknowledged, preserved and built upon. I look forward to the discussions that will ensure when this Report is publicised and discussed by the professionals and other interested parties. For those interested, the Report can be accessed at www.who.int/whr.
Errol Miller is Professor and head of the Institute of Education, UWI, Mona.
